What Is an Episiotomy and Why Is It So Controversial?

March 16, 2019
Although episiotomy is common in traditional medicine, it has become quite controversial. What are the risks of an episiotomy? What are its advantages?

You should know what an episiotomy is if you’re having a vaginal delivery. This surgery involves making an incision in the woman’s perineum when she’s about to give birth in order to make it easier for the baby to pass through.

Episiotomies are controversial. While they’re performed in up to 80% of births in Latin America and Spain, the World Health Organization claims that this technique is contraindicated and only recommends it in extreme cases.

What is an episiotomy?

Episiotomies are common surgical interventions during vaginal childbirth in Latin America and Spain.

It involves a surgical cut of the perineum under anesthesia. Thus, it consists of tearing skin, vaginal mucosa and muscle to enlarge the vaginal canal to make it easier for the baby to pass through.

Although the incision is directed toward the anus, it’s made laterally or downward precisely to avoid damaging the anal sphincter. There are several reasons why doctors recommend them:

  • When the fetus is too big.
  • If the perineum is very muscular.
  • Multiple births (twins or triplets, for example).
  • Assisted vaginal delivery.
  • Low vulvar and vaginal elasticity.
  • When young teenagers are going to give birth.
  • When the baby has shoulder dystocia.
Why Is an Episiotomy and Why Is It So Controversial?

Why is this technique controversial?

It’s controversial because two of the main reasons why this technique was done didn’t prevent damage to the mother’s genital area. Episiotomy was supposed to prevent vaginal prolapse and tears in the vagina, perineum, and anus.

According to research, it was best to perform a surgical incision so the patient didn’t suffer a tear. Although doctors believed that episiotomy recovery was much faster, they later discovered that this wasn’t the case.

The most alarming thing about this technique is its statistics. Among other things, the statistics reflect a high morbidity rate for the mother, as a result of various complications.

To illustrate the situation, here is a list of the potential side effects of an episiotomy:

  • Vulvar and perineal varicose veins.
  • Painful scarring.
  • Worsened hemorrhoids.
  • Rectovaginal fistulas.
  • Muscle and nerve retraction.
  • Abscesses.
  • Infection and reopening of the wound.
  • Painful intercourse.
  • Partial or permanent fecal incontinence.
  • Psychological trauma.

The World Health Organization (WHO) no longer recommends routine or liberal use of episiotomy for women undergoing spontaneous vaginal birth.

Why Is an Episiotomy and Why Is It So Controversial?

On the contrary, it should only be considered in cases where women have suffered mainly third- and fourth-degree tears that haven’t healed well, when forceps need to be used, or because babies are suffering considerably or their life is at risk. In short, only in extreme emergencies.

Episiotomy suture care

These quick tips can help if you underwent an episiotomy:

  • Keep the wound dry and clean.
  • When you go to the bathroom, wash and air dry the area. You can use a fan or a towel exclusively for this area.
  • Change your postpartum pads regularly.
  • Use ice to relieve pain and reduce inflammation.
  • Don’t exert yourself nor lift anything until the wound heals.

As a final recommendation, you should know that, before childbirth, you can discuss with your doctor whether you want to get an episiotomy or not. If the doctor believes your case is complicated, they might also recommend a Cesarean section.